S T A T E   O F   N E W   Y O R K
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                                  4182

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                             March 22, 2011
                               ___________

Introduced  by  Sen.  RANZENHOFER -- read twice and ordered printed, and
  when printed to be committed to the Committee on Health

AN ACT to amend the  social  services  law,  in  relation  to  mandatory
  managed care for certain recipients of medical assistance

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Paragraph (b) of subdivision 1  of  section  364-j  of  the
social  services  law,  as  amended  by chapter 649 of the laws of 1996,
subparagraphs (i) and (ii) as amended by chapter  433  of  the  laws  of
1997, is amended to read as follows:
  (b)  "Managed  care provider". An entity that provides or arranges for
the provision of medical assistance services  and  supplies  to  partic-
ipants  directly  or  indirectly (including by referral), including case
management; and:
  (i) is authorized to operate under article forty-four  of  the  public
health  law  or article forty-three of the insurance law and provides or
arranges, directly or indirectly (including  by  referral)  for  covered
comprehensive health services on a full capitation basis; [or]
  (ii)  is  authorized  as  a  partially  capitated  program pursuant to
section three hundred sixty-four-f of this title or  section  forty-four
hundred  three-e of the public health law or section 1915b of the social
security act;
  (III) IS A RURAL HEALTH NETWORK  AS  DEFINED  IN  SUBDIVISION  TWO  OF
SECTION TWENTY-NINE HUNDRED FIFTY-ONE OF THE PUBLIC HEALTH LAW; OR
  (IV)  HOLDS  A  COMPREHENSIVE  HIV  SPECIAL  NEEDS PLAN CERTIFICATE OF
AUTHORITY PURSUANT TO SECTION FORTY-FOUR HUNDRED THREE-C OF  THE  PUBLIC
HEALTH LAW.
  S  2.  Paragraph  (g)  of subdivision 3 of section 364-j of the social
services law, as amended by chapter 649 of the laws  of  1996,  subpara-
graph  (i)  as amended by section 30 of part C of chapter 58 of the laws
of 2008, is amended to read as follows:

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD02425-01-1
              

S. 4182                             2

  (g) The following categories of individuals will [not] be required  to
enroll  with  a  managed  care program [until] FOLLOWING THE APPROVAL OF
program features and reimbursement rates [are approved] by  the  commis-
sioner of health and, as appropriate, the commissioner of mental health:
  (i)  an individual dually eligible for medical assistance and benefits
under the federal Medicare program and enrolled in  a  Medicare  managed
care  plan  offered  by  an entity that is also a managed care provider;
provided that (notwithstanding paragraph (g) of subdivision four of this
section):
  (a) if the individual changes his or her Medicare managed care plan as
authorized by title XVIII  of  the  federal  social  security  act,  and
enrolls  in  another  Medicare  managed care plan that is also a managed
care provider, the individual shall be (if required by the  commissioner
under this paragraph) enrolled in that managed care provider;
  (b) if the individual changes his or her Medicare managed care plan as
authorized  by  title  XVIII  of  the  federal  social security act, but
enrolls in another Medicare managed care plan that is not also a managed
care provider, the individual shall be disenrolled from the managed care
provider in which he or she was enrolled and withdraw from  the  managed
care program;
  (c) if the individual disenrolls from his or her Medicare managed care
plan  as  authorized  by title XVIII of the federal social security act,
and does not enroll in another Medicare managed care plan, the  individ-
ual  shall  be disenrolled from the managed care provider in which he or
she was enrolled and withdraw from the managed care program;
  (d) nothing herein shall require an individual enrolled in  a  managed
long  term  care plan, pursuant to section forty-four hundred three-f of
the public health law, to disenroll from such program.
  (ii) an individual eligible for supplemental security income;
  (iii) HIV positive individuals; and
  (iv) persons with serious mental illness and children and  adolescents
with  serious  emotional disturbances[, as defined in section forty-four
hundred one of the public health law].
  S 3. Section 364-j of the social services law is amended by adding two
new subdivisions 25 and 26 to read as follows:
  25. THE COMMISSIONER OF HEALTH SHALL TAKE ALL MEASURES  NECESSARY  AND
CONVENIENT  TO  CAUSE  ALL  SOCIAL  SERVICES  DISTRICTS IN THE STATE NOT
ALREADY DOING SO TO PROVIDE MEDICAL ASSISTANCE AND IMPLEMENT THE STATE'S
MANAGED CARE PROGRAM AND PARTICIPATE IN SUCH PROGRAM AUTHORIZED BY  THIS
SECTION.
  26.  THE  COMMISSIONER OF HEALTH SHALL SUBMIT THE APPROPRIATE WAIVERS,
STATE PLAN AMENDMENTS AND FEDERAL APPLICATIONS, INCLUDING BUT NOT LIMIT-
ED TO, WAIVER REQUESTS AUTHORIZED PURSUANT TO  SECTIONS  ELEVEN  HUNDRED
FIFTEEN AND NINETEEN HUNDRED FIFTEEN OF THE FEDERAL SOCIAL SECURITY ACT,
OR SUCCESSOR PROVISIONS, AS THE COMMISSIONER OF HEALTH SHALL DEEM NECES-
SARY  TO  SECURE APPROPRIATE FEDERAL FINANCIAL SUPPORT FOR THE COST OF A
PROGRAM TO AUTHORIZE  MANDATORY  MANAGED  CARE  FOR  MEDICAL  ASSISTANCE
RECIPIENTS  RESIDING  IN ALL AREAS OF THE STATE, INCLUDING RECIPIENTS OF
SUPPLEMENTAL INCOME AND PERSONS ENROLLED OR ELIGIBLE TO BE ENROLLED IN A
MEDICARE TEFRA PLAN.
  S 4. Section two of this act shall not take effect  unless  and  until
the commissioner of health receives all necessary approvals under feder-
al  law  and  regulation  to implement its provisions, and provided that
such provisions do not prevent the receipt of federal financial  partic-
ipation under the medical assistance program. The commissioner of health
shall  submit  such  waiver applications and/or state plan amendments as

S. 4182                             3

may be necessary to obtain such approvals and to ensure continued feder-
al financial participation.
  S  5.  This act shall take effect immediately; provided, however, that
the amendments to section 364-j of  the  social  services  law  made  by
sections  one,  two and three of this act shall not affect the repeal of
such section pursuant to chapter 710 of the laws of  1988,  as  amended,
and  shall  be deemed repealed therewith; provided that the commissioner
of health shall notify the legislative bill drafting commission upon the
occurrence of the enactment of the legislation provided for  in  section
two  of  this  act in order that the commission may maintain an accurate
and timely effective data base of the official text of the laws  of  the
state  of New York in furtherance of effecting the provisions of section
44 of the legislative law and section 70-b of the public officers law.